• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

About FDA

  • Print
  • Share
  • E-mail

Staff Manual Guide 2310.3, Attachment G



From: Chief, Accounting Branch, FDA
Subject: Salary Offset Request - Emergency Employee Payment Not Repaid
To: Division of Personnel and Pay Systems
Payroll Accounting Group - Room 1000
330 Independence Avenue, S.W.
Washington, D.C. 20201
ATTN: Reconciliation Team


We are requesting your assistance in collecting the following employee debt via salary/ retirement offset.

1. Employee Name: ______________________________________SSN:________________________

Timekeeper Number: ______________________

2. I certify that this is a valid debt and that the precise amount of the debt owed is $________ through _____________. It consists of $___________ principal, $_________ interest, $_________ administrative cost, and a 6% penalty of $_________. (Payroll's administrative cost charges are not included in these amounts.)

3. Attached are copies of the documentation of the debt (travel advances, vouchers, etc.)

4. Check only one.

4a. ___The amount to be withheld each pay period is 15 percent of disposable pay until the full amount is recovered.

4b. ___The amount to be withheld each pay period is $_______ as the employee agreed to this amount, in writing (copy of employee consent is attached.) Deduct this amount for ____ pay periods, and deduct $______ the last pay period.

4c. ___The amount to be withheld is the full amount of the debt from the employee's last pay and/or lump sum leave payment as the employee is leaving Government service.

5. The legislative and regulatory source of authority for administrative offset is the Debt Collection Act of 1982 (P.L. 97-365) at 31 U.S.C. 3716; 5 U.S.C. 5514, as implemented by 45 CFR 30.15.

6. I certify that the employee has been notified in writing of the debt and his due process rights. See attached demand letter, including notification of pending offset action. The employee never responded ______ or the debt has been ruled valid and correct _____, after review.

7. Please credit CAN: ___________________ Appropriation: _____________________

8. Agency Location Code: _______________________

9. Mail SF 1081 to:










For further information, please contact _________________________ on _____________.



David R. Petak
Chief, Accounting Branch


cc: Servicing Personnel Office - Employee Record